Atrial fibrillation (AF) frequently arises from an abnormal focus at or near the junction of the pulmonary veins and the left atrium, thus leading to the feasibility of more focused ablation techniques directed at these structures. Catheter-based ablation, using radiofrequency ablation (RFA) or cryoablation, is being studied as a treatment option for various types of AF. Circumferential pulmonary vein ablation using radiofrequency energy is the most common approach to catheter ablation. Cryoablation using a catheter to damage or destroy abnormal foci by applying extreme cold is also used. Other energy sources, such as laser, are under investigation for this indication.
AF can be subdivided into 3 types:
Although catheter ablation is a common treatment for atrial fibrillation, significant adverse events do occur. Studies report serious adverse event rates from 4% to 9% including vascular complications at the site of catheter insertion (usually groin) and more rarely, serious cardiovascular events such as tamponade, stroke, and death.
New York Heart Association (NYHA) Classification of Heart Failure:
The NYHA classification consists of 4 categories of heart failure based on a patient’s limitation during physical activity.
| Class | Patient Symptoms |
| I | No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). |
| II | Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). |
| III | Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. |
| IV | Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases. |
Source: https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-of-heart-failure
I. Transcatheter radiofrequency ablation or cryoablation to treat atrial fibrillation may be considered MEDICALLY NECESSARY AND APPROPRIATE when the following criteria are met:
II. Transcatheter radiofrequency ablation or cryoablation to treat atrial fibrillation may be considered MEDICALLY NECESSARY AND APPROPRIATE as an initial treatment for patients when BOTH of the following criteria are met:
III. Repeat radiofrequency ablation or cryoablation may be considered MEDICALLY NECESSARY AND APPROPRIATE when EITHER of the following are met:
IV. Transcatheter radiofrequency ablation or cryoablation as a treatment of atrial fibrillation that does not meet the criteria outlined above is considered EXPERIMENTAL/INVESTIGATIVE due to a lack of clinical evidence demonstrating an impact on improved health outcomes.
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